BMJ Case Reports 2012; doi:10.1136/bcr.01.2012.5539
  • Unusual association of diseases/symptoms

An unusual cause of blackout with transient loss of consciousness: Prinzmetal angina

  1. Javed Akhtar4
  1. 1Department of Cardiology, St Thomas’ Hospital, London, UK
  2. 2Department of Intensive Care, Broomfield Hospital, Chelmsford, UK
  3. 3Department of Medicine, Queen Mary and Westfield Medical School, London, UK
  4. 4Department of Cardiology, Queens Hospital, Romford, UK
  1. Correspondence to Dr Mohammed Majid Akhtar, gogetmajid{at}

The authors present the case of a 61-year-old woman who was troubled by regular episodes of throat discomfort, headache, dyspnoea and tingling sensation in the upper limbs. These were associated with occasional episodes of transient loss of consciousness accompanied by urinary incontinence over a period of 5 years. As these episodes became increasingly frequent, she was referred to a neurologist. Initial neurological assessment and investigations had a negative diagnostic yield and she was therefore referred for cardiac review. A repeat 24 h Holter revealed intermittent episodes of significant ST-segment elevation associated with a Mobitz type II atrio-ventricular block correlating with her symptoms. Her echocardiography and coronary angiography were normal; hence a diagnosis of Prinzmetal angina was made. She was treated appropriately with nitrates and a calcium channel blocker and followed up in cardiology clinic with no further recurrence of symptoms.


  • Competing interests None.

  • Patient consent Obtained.

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